Following the April revisions to the medical service fee system, group therapy for patients undergoing rehabilitation treatment is no longer covered by medical insurance.
As an occupational therapist, I have been engaged in the treatment of both inpatients and outpatients at specialist rehabilitation and geriatric health-care facilities for the past three decades. I have also conducted long-term research on people with disabilities who receive care at home. Currently, I teach occupational therapy at the university level.
I believe comprehensive rehabilitation is indispensable to Japan's rapidly aging society and am therefore afraid the recent revision will bring devastating consequences.
Since it was first included in the medical insurance system in 1974, rehabilitation treatment had been covered under two classifications, namely "individual" and "group" therapies.
Along with rehabilitation medicine, it is considered vital for people with mental and physical disabilities to take part in group therapies so that they may share their pains, sense of isolation, anxieties and other common difficulties.
The rapport developed between group members helps each of them face these hurdles and envision their future.
Indeed, such "peer support" forms the practical philosophy of group therapy, according to Hitoshi Ota, professor emeritus at the Ibaraki Prefectural University of Health Sciences.
This thinking is also behind the phrase "the best teacher for aphasiacs is an aphasiac." In other words, some things are better learned from those who have been there before.
Doctors and therapists observe individuals in a group and provide treatment to meet their individual needs.
While patients are hospitalized, they undergo a combination of group and individual therapies as they prepare to return to their communities.
When they are released from hospital, many still take part in group therapy as outpatients.
The purpose of such programs is to help them deal with the confusion they may face in their daily life as well as a common sense of isolation and loss of drive.
On average, it takes more than three years to overcome such problems. Therefore, in addition to hospital outpatient programs, "functional training programs" based on the Health and Medical Service Law for the Elderly have also served as a forum to provide peer support.
Rehabilitation is extremely important to people with disabilities who want to establish independence. Denying them group therapy is tantamount to denying their right to rehabilitation.
The Japan Association of Rehabilitation Hospital and Institution defines rehabilitation as "the process for persons with disabilities to gain the best mental and physical conditions commensurate with their age and degree of disabilities so that they may maintain the same standard of living as others who live in their communities in every way."
The decision to exclude group therapy from medical insurance coverage runs counter to this spirit.
Looking at revisions of other policies related to health and nursing care, I get the impression the government has unreasonably decided that treating patients in "groups" provides no solution to problems that affect "individuals."
However, I doubt that rehabilitation medicine would be as effective through individual therapy alone.
Humans are social beings who need each other and find it hard to cope by themselves.
Moreover, as our society grows older, the field of rehabilitation medicine will become more important than ever.
Under such circumstances, I believe the implementation of "peer support" can serve as an important means to bring people together and help solve the various problems of an aging society.
I therefore strongly demand the reinstatement of group therapy treatment in insurance coverage for rehabilitation medicine.
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The author is a professor of occupational therapy at Fujita Health University.(IHT/Asahi: July 1,2006)
